World Journal ofClinical Cases

World J Clin Cases 2019 August 6; 7(15): 1908-2133

ISSN 2307-8960 (online)

Published by Baishideng Publishing Group Inc

W J C C World Journal ofClinical Cases

Contents Semimonthly Volume 7 Number 15 August 6, 2019

REVIEW1908 Bone alterations in inflammatory bowel diseases

Sgambato D, Gimigliano F, De Musis C, Moretti A, Toro G, Ferrante E, Miranda A, De Mauro D, Romano L, Iolascon G,

Romano M

MINIREVIEWS1926 Extrahepatic hepcidin production: The intriguing outcomes of recent years

Daher R, Lefebvre T, Puy H, Karim Z

1937 Neoadjuvant endocrine therapy: A potential strategy for ER-positive breast cancerYao LT, Wang MZ, Wang MS, Yu XT, Guo JY, Sun T, Li XY, Xu YY

ORIGINAL ARTICLE

Basic Study

1954 Vestigial like family member 3 is a novel prognostic biomarker for gastric cancerZhang LH, Wang Z, Li LH, Liu YK, Jin LF, Qi XW, Zhang C, Wang T, Hua D

Retrospective Study

1964 HER2 heterogeneity is a poor prognosticator for HER2-positive gastric cancerKaito A, Kuwata T, Tokunaga M, Shitara K, Sato R, Akimoto T, Kinoshita T

Case Control Study

1978 Changes in corneal endothelial cell density in patients with primary open-angle glaucomaYu ZY, Wu L, Qu B

Observational Study

1986 Myocardial bridge-related coronary heart disease: Independent influencing factors and their predicting

valueZhao DH, Fan Q, Ning JX, Wang X, Tian JY

1996 Clinical significance and role of up-regulation of SERPINA3 expression in endometrial cancerZhou ML, Chen FS, Mao H

2003 Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent

spatiotemporal image correlationSun JX, Cai AL, Xie LM

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15I

ContentsWorld Journal of Clinical Cases

Volume 7 Number 15 August 6, 2019

2013 Correlation between intracoronary thrombus components and coronary blood flow after percutaneous

coronary intervention for acute myocardial infarction at different onset timeZhang MJ, Liu X, Liu LH, Li N, Zhang N, Wang YQ, Sun XJ, Huang PH, Yin HM, Liu YH, Zheng H

META-ANALYSIS2022 Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with

chronic hepatitis B: A systematic review and meta-analysisXu XY, Wang WS, Zhang QM, Li JL, Sun JB, Qin TT, Liu HB

CASE REPORT2038 Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report

Moura DTHD, Sachdev AH, Lu PW, Ribeiro IB, Thompson CC

2044 Left colonic metastasis from primary hepatocellular carcinoma: A case reportTagliabue F, Burati M, Chiarelli M, Marando A, Simone MD, Cioffi U

2049 ALK-positive anaplastic large cell lymphoma presenting multiple lymphomatous polyposis: A case report

and literature reviewSaito M, Izumiyama K, Ogasawara R, Mori A, Kondo T, Tanaka M, Morioka M, Miyashita K, Tanino M

2058 Modified Tong Xie Yao Fang relieves solitary rectal ulcer syndrome: A case reportZhang LL, Hao WS, Xu M, Li C, Shi YY

2065 Hydrogen gas therapy induced shrinkage of metastatic gallbladder cancer: A case reportChen JB, Pan ZB, Du DM, Qian W, Ma YY, Mu F, Xu KC

2075 Giant nonfunctional ectopic adrenocortical carcinoma on the anterior abdominal wall: A case reportZhou DK, Liu ZH, Gao BQ, Wang WL

2081 Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the femur: A case reportTang D, Wang XM, Zhang YS, Mi XX

2087 Gastric duplication cyst mimicking large cystic lymphangioma in an adult: A rare case report and review of

the literatureXv FY, Sun A, Gan Y, Hu HJ

2094 Endometriosis of the duplex appendix: A case report and review of the literatureZhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY

2103 Fever and neck pain after pacemaker lead extraction: A case reportWang SX, Bai J, Ma R, Lan RF, Zheng J, Xu W

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15II

ContentsWorld Journal of Clinical Cases

Volume 7 Number 15 August 6, 2019

2110 c.753_754delAG, a novel CFTR mutation found in a Chinese patient with cystic fibrosis: A case report and

review of the literatureWang YQ, Hao CL, Jiang WJ, Lu YH, Sun HQ, Gao CY, Wu M

2120 Common iliac artery occlusion with small intestinal transection caused by blunt abdominal trauma: A case

report and review of the literatureZhou YX, Ji Y, Chen J, Yang X, Zhou Q, Lv J

2128 Percutaneous coronary intervention for ostial lesions of the left main stem in a patient with congenital single

left coronary artery: A case reportWu Q, Li ZZ, Yue F, Wei F, Zhang CY

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15III

ContentsWorld Journal of Clinical Cases

Volume 7 Number 15 August 6, 2019

ABOUT COVER Editorial Board Member of World Journal of Clinical Cases, Shu-Pin Huang,MD, Associate Professor, Attending Doctor, Director, Department ofUrology, Kaohsiung Medical University, Kaohsiung 807, Taiwan

AIMS AND SCOPE World Journal of Clinical Cases (World J Clin Cases, WJCC, online ISSN 2307-8960, DOI: 10.12998) is a peer-reviewed open access academic journal thataims to guide clinical practice and improve diagnostic and therapeutic skillsof clinicians. The primary task of WJCC is to rapidly publish high-quality Case Report,Clinical Management, Editorial, Field of Vision, Frontier, Medical Ethics,Original Articles, Meta-Analysis, Minireviews, and Review, in the fields ofallergy, anesthesiology, cardiac medicine, clinical genetics, clinicalneurology, critical care, dentistry, dermatology, emergency medicine,endocrinology, family medicine, gastroenterology and hepatology, etc.

INDEXING/ABSTRACTING The WJCC is now indexed in PubMed, PubMed Central, Science Citation Index

Expanded (also known as SciSearch®), and Journal Citation Reports/Science Edition.

The 2019 Edition of Journal Citation Reports cites the 2018 impact factor for WJCC

as 1.153 (5-year impact factor: N/A), ranking WJCC as 99 among 160 journals in

Medicine, General and Internal (quartile in category Q3).

RESPONSIBLE EDITORS FORTHIS ISSUE

Responsible Electronic Editor: Yan-Xia Xing

Proofing Production Department Director: Yun-Xiaojian Wu

NAME OF JOURNALWorld Journal of Clinical Cases

ISSNISSN 2307-8960 (online)

LAUNCH DATEApril 16, 2013

FREQUENCYSemimonthly

EDITORS-IN-CHIEFDennis A Bloomfield, Sandro Vento

EDITORIAL BOARD MEMBERShttps://www.wjgnet.com/2307-8960/editorialboard.htm

EDITORIAL OFFICEJin-Lei Wang, Director

PUBLICATION DATEAugust 6, 2019

COPYRIGHT© 2019 Baishideng Publishing Group Inc

INSTRUCTIONS TO AUTHORShttps://www.wjgnet.com/bpg/gerinfo/204

GUIDELINES FOR ETHICS DOCUMENTShttps://www.wjgnet.com/bpg/GerInfo/287

GUIDELINES FOR NON-NATIVE SPEAKERS OF ENGLISHhttps://www.wjgnet.com/bpg/gerinfo/240

PUBLICATION MISCONDUCThttps://www.wjgnet.com/bpg/gerinfo/208

ARTICLE PROCESSING CHARGEhttps://www.wjgnet.com/bpg/gerinfo/242

STEPS FOR SUBMITTING MANUSCRIPTShttps://www.wjgnet.com/bpg/GerInfo/239

ONLINE SUBMISSIONhttps://www.f6publishing.com

© 2019 Baishideng Publishing Group Inc. All rights reserved. 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

E-mail: bpgoffice@wjgnet.com https://www.wjgnet.com

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15IX

W J C C World Journal ofClinical Cases

Submit a Manuscript: https://www.f6publishing.com World J Clin Cases 2019 August 6; 7(15): 2058-2064

DOI: 10.12998/wjcc.v7.i15.2058 ISSN 2307-8960 (online)

CASE REPORT

Modified Tong Xie Yao Fang relieves solitary rectal ulcer syndrome:A case report

Li-Li Zhang, Wan-Shan Hao, Meng Xu, Chang Li, Yuan-Yuan Shi

ORCID number: Li-Li Zhang(0000-0002-6906-8893); Wan-ShanHao (0000-0002-1222-6723); MengXu (0000-0003-3070-0123); Chang Li(0000-0003-4008-0167); Yuan-YuanShi (0000-0003-2997-4573).

Author contributions: Zhang LL,Hao WS and Xu M contributedequally to this work; Hao WS andShi YY designed the research;Zhang LL, Xu M and Li Cperformed the research; Zhang LL,Hao WS, Xu M and Shi YY wrotethe paper; All authors have readand approved the final version tobe published.

Supported by the Start-up Fundfrom Beijing University of ChineseMedicine, No. 1000061020044.

Institutional review boardstatement: The InstitutionalReview Board of Beijing Universityof Chinese Medicine providedapproval for this study.

Informed consent statement:Written informed consent wasobtained from the patient forpublication of this report and anyaccompanying images.

Conflict-of-interest statement: Theauthors declare that they have noconflicts of interest.

CARE Checklist (2016) statement:The authors have read the CAREChecklist (2016), and themanuscript was prepared andrevised according to the CAREChecklist (2016).

Open-Access:This article is anopen-access article which wasselected by an in-house editor and

Li-Li Zhang, Meng Xu, Yuan-Yuan Shi, School of Life Sciences, Beijing University of ChineseMedicine, Beijing 100029, China

Wan-Shan Hao, Teaching and Research Section of Shanghan, Beijing University of ChineseMedicine, Beijing 100029, China

Chang Li, Traditional Chinese Medicine Department, Beijing Baicaoyuan Hospital ofTraditional Chinese Medicine, Beijing 100107, China

Corresponding author: Yuan-Yuan Shi, PhD, Professor, School of Life Sciences, BeijingUniversity of Chinese Medicine, No. 11 East road, North 3rd Ring Road, Beijing 100029,China. yshi@bucm.edu.cnTelephone: +86-10-53912150Fax: +86-10-64286651

AbstractBACKGROUNDSolitary rectal ulcer syndrome (SRUS) is a rare rectal disorder characterized bybloody mucus in the stool, difficulty in defecation, pain, and anal swelling. Todate, the etiology of this syndrome remains not well understood and thediagnosis is frequently confused with other disorders, making treatment a clinicalchallenge.

CASE SUMMARYA 50-year-old woman presented to our hospital with a 40-d history of bloodymucus in the stool and anal swelling. SRUS was suspected. Rectoscopy revealed alarge, severe ulcerous lesion. Histologically, the lesion was characterized aschronic ulcer without clear tumor cells, and the final diagnosis of SRUS wasmade. The patient was treated with Chinese medicine therapy, withadministration of Tong Xie Yao Fang. After 3 wk of treatment, the symptomsimproved significantly. At 2-mo follow-up, rectoscopy in a local hospital showedhealed ulcer scars without obvious protrusion 3 cm from the anal verge.

CONCLUSIONChinese medicine therapy represents a potential treatment of SRUS withpredominant rectal bleeding, mucinous discharge, and anal swelling pain.

Key words: Solitary rectal ulcer syndrome; Chinese formulas; Tong Xie Yao Fang; ErShen Wan; Ding Zhi Xiao Wan; Chinese medicine therapy; Case report

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 152058

fully peer-reviewed by externalreviewers. It is distributed inaccordance with the CreativeCommons Attribution NonCommercial (CC BY-NC 4.0)license, which permits others todistribute, remix, adapt, buildupon this work non-commercially,and license their derivative workson different terms, provided theoriginal work is properly cited andthe use is non-commercial. See:http://creativecommons.org/licenses/by-nc/4.0/

Manuscript source: Unsolicitedmanuscript

Received: April 16, 2019Peer-review started: April 16, 2019First decision: May 9,2019Revised: June 17, 2019Accepted: June 27, 2019Article in press: June 27,2019Published online: August 6, 2019

P-Reviewer: Biondi A, Zielinski JS-Editor: Dou YL-Editor: Wang TQE-Editor: Wu YXJ

©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

Core tip: Solitary rectal ulcer syndrome (SRUS) is a benign but uncommon rectaldisorder. We present the case of a 50-year-old woman who suffered from SRUS for 40 d,with the symptoms of bloody mucous in the stools and anal swelling. Following oursuccess of treatment with modified Tong Xie Yao Fang, we discuss how this traditionalChinese medicine prescription might be an effective treatment strategy for SRUS withthis symptom profile.

Citation: Zhang LL, Hao WS, Xu M, Li C, Shi YY. Modified Tong Xie Yao Fang relievessolitary rectal ulcer syndrome: A case report. World J Clin Cases 2019; 7(15): 2058-2064URL: https://www.wjgnet.com/2307-8960/full/v7/i15/2058.htmDOI: https://dx.doi.org/10.12998/wjcc.v7.i15.2058

INTRODUCTIONSolitary rectal ulcer syndrome (SRUS) is a chronic, benign, uncommon and under-diagnosed disease. It is estimated that the annual incidence of SRUS is one of 100000people, mainly affecting men in the third decade of life and women in the fourthdecade[1]. Its symptomological profile consists of intestinal symptoms, primarilyconstipation, feeling of incomplete defecation, bloody or purulent stools, discomfortwith falling anus, and rectal ulcers.

The diagnosis of SRUS is largely based on findings in rectoscopy and analysis oftissue biopsy. The treatment of SRUS includes local medication, improvement ofbowel defecation habits, biofeedback, and surgical operation[2]. We report herein thecase of a 50-year-old woman with SRUS and describe its appearance on rectoscopyand in analysis of the gross specimen following Chinese medicine therapy. Thepurpose of publishing this case is to report and discuss the effects of herbal therapyon SRUS.

CASE PRESENTATION

Chief complaintsA 50-year-old woman presented to our hospital with a 2-year history of intermittentdull pain in her left lower abdomen, a 40-d history of rectal swelling and discomfort,and a 20-d history of mucinous and bloody, loose stools.

History of present illnessThe patient was sent to our Chinese medicine hospital on September 5, 2018. Shereported having had developed intermittent left lower abdominal dull pain 2 yearsprior, after suffering from cold and eating irritating food. She reported no obviouscause of the rectal swelling discomfort that had developed 2 mo previously nor of themucinous bloody, loose stools (occurring three or four times a day) 40 d prior. Shealso reported insomnia, and we observed her tongue to be red in color with white andthick fur, and a thin pulse.

History of past illness and family historyThe patient had undergone hemorrhoid surgery in 2009 and polypectomy of thecervical canal in 2011. Her father had died of a femoral fracture in the neck; otherwise,there was no medical family history.

Physical examination upon admissionPhysical examination showed no obvious abnormality, except for a tough ulcerativemass, about 2 cm × 2 cm on the wall of the rectum at 3 cm from the anal verge. Theremaining rectal mucosa showed smooth surface. Blood stains were detected on thedoctor’s disposable glove after examination of the patient.

Laboratory examinationsLaboratory examinations provided the following findings: Gram-positive bacilli of40.0% (normal range: 50%-71%); Gram-negative bacilli of 45.0% (normal range: 24%-44%); antigen-stimulated interferon A of 15.0 SFCs/2.5 × 106 (normal: < 6 SFCs/2.5 ×

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2059

106); specific gravity of urine of 1.008 (normal range: 1.015-1.025); total cholesterol of5.2 mmol/L (normal: < 5.18 mmol/L); and complement C1q of 149.0 mg/L (normalrange: 159-233 mg/L). The white blood cell count (5.99 × 109/L) and platelet count(4.03 × 1012/L) were normal. Findings for stool samples’ cultures, fecal occult blood,parasite eggs, and amoeba trophozoites were negative.

Imaging examinationsColonoscopy revealed an irregular nodule, occupying 1/2 of the lumen, at 5 cm fromthe anal verge. The central ulcer was sunken, with blood stasis spotting and sloughingon the surface, as well as being brittle and bleeding easily (Figure 1A). Rectoscopeshowed a large ulcerative lesion at 2-4 cm from the anal margin of the rectum,occupying 3/5 of the lumen, covered by a white and bloody sloughing of tissue withcentral ulcer depression, as well as being brittle and prone to bleeding (Figure 1B).The pathological report noted chronic colonic mucositis, rectal mucosal erosion, andinflammatory granulation (Figure 1C).

FINAL DIAGNOSISThe patient was diagnosed with SRUS, based on the findings from endoscopy of therectum and colon (Figure 1A, B) and histology of the biopsy (Figure 1C). Hercondition was deemed to be serious. Diagnosis of Traditional Chinese Medicine(TCM) was diarrhea (liver stagnation and spleen deficiency), according to thepatient’s main clinical symptoms.

TREATMENTTreatment of modified Tong Xie Yao Fang (TXYF) was administered to soothe the qi,fortify the spleen, quiet the heart, astringe the intestines, regulate the diarrhea, andrelieve the pain. The prescription was composed of Chenpi (tangerine peel; 15 g),Baishao (Radix Paeoniae Alba; 20 g), Fangfeng (Radix Saposhnikoviae; 20 g), Gaoben(Ligusticum; 10 g), Baizhu [Rhizoma Atractylodis Macrocephalae (AM); 15 g],Roudoukou (Myristica fragrans; 10 g), Buguzhi (Psoralea corylifolia; 10 g), Paojiang(prepared ginger; 10 g), Pugongying (Mongolian dandelion; 20 g), Dangshen (RadixCodonopsis; 15 g), Yuanzhi (Polygala Tenuifolia; 12 g), Shichangpu (AcorusTatarinowii; 10 g), and Gancao (licorice; 10 g). The daily dose was decocted withwater and taken at 30 min after food intake in the morning and evening. After 7 d, onSeptember 12, 2018, the patient’s symptoms were alleviated but the patient wokeearly in the morning, with the continued red tongue with white and thick fur, andthin, wiry pulse. Suanzaoren (spine date seed; 20 g), Hehuanpi (Silktree Albizia bark;10 g), and Fuling (Poria Cocos; 15 g) were added into the original prescription. Thedecoction and delivery method was the same as the initial ones. TCM treatment hadbeen insisted on by the patient, who only wanted Chinese herbal medicine and noWestern medicine treatment for 21 d.

OUTCOME AND FOLLOW-UPOn September 30, 2018, the patient was examined in the Third Affiliated Hospital ofBeijing University. Rectoscopy showed an irregular shaped ulcer, 3 cm from the analverge, about 1.0 cm × 1.2 cm in size, less white fur on the surface, flat bottom,concentrated folds around the rectum, and fusion, thickening and interruption nearthe ulcer; the biopsy specimen was tough, with no stenosis (Figure 2A). Thepathological report noted chronic rectal ulcer mucosal inflammation, with focallymphocyte aggregation (Figure 2B). The results suggested that the ulcer surfacetended to be scarred, having improved and healed without prescribed Westernmedicine. The improvement of rectal symptoms in this patient should be attributed tothe role of the 21 herbs administered.

During hospitalization, the patient underwent a series of examinations. Althoughthe cause of SRUS was not found, the ulcer improved gradually with treatment. Afterdischarge, the woman adhered to TCM treatment and also used Titanoreine, a kind ofanal suppository the covers the surface of the anal and rectal mucosa with a protectivemembrane. On December 8, 2018, re-examination by rectoscopy in a local hospitalshowed that the ulcer scars had healed, without obvious protrusion, at 3 cm from theanal verge. A polyp, about 0.3 cm × 0.3 cm, was found at 3 cm from the anal verge.The surface of the mucosa was found to be smooth (Figure 2C).

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2060

Figure 1

Figure 1 Endoscopic images and corresponding histological findings from before the Traditional ChineseMedicine treatment. A: Colonoscopy image showing actively bleeding, deep ulcerations; B: Rectoscope imageshowing a large ulcerative lesion covered by a white and bloody sloughing tissue; C: Hematoxylin-eosin-stained rectalulcers.

DISCUSSIONThe pathogenesis of SRUS is not clear, and it is often believed that SRUS might beassociated with rectal prolapse and trauma from straining[3,4]. Clinically, SRUS is easyto be suspected as colorectal cancer, based on the similar symptomatic profiles andendoscopic features, which include bleeding or mucus at defecation, anal or rectalpain and discomfort, increased frequency of defecation, and colorectal masses orulcers[1,5]. Histological features are helpful to distinguish SRUS from malignancy. Thekey histological features that distinguish SRUS from colorectal cancer are thearchitectural distortion, fibromuscular obliteration of lamina propria, and absence oftumor cell infiltration[6].

The therapeutic regimens for SRUS include conservative treatment, medicaltherapy, biofeedback therapy, and surgery[2]. The choice of treatment depends uponthe severity of symptoms and the presence of rectal prolapse. In our case, TCM mayhave played a role in the successful treatment of SRUS and highlights the potential ofsuch as a supplementary and alternative therapy. Some studies have suggested thatfruits, vegetables and grains have protective effects against adenoma and colorectalcancer. Probiotics may also have preventive effects on colorectal cancer but the actualbeneficial effects remain to be definitively evidenced[7,8]. Conservative treatment (high-fiber diet, laxatives, change in defecatory habits, and biofeedback treatment) wereshown to induce a symptomatic improvement in 71/91 patients (63.6%) and healingof mucosal lesion in 17/51 patients (33.3%)[9]. According to those reports, SRUS maybe prevented and improved by adjusting dietary structures and probiotic levels.

The basic TCM prescription combination consists of three classic Chinese formulas,(TXYF, consisting of tangerine peel, Radix Paeoniae Alba, Radix Saposhnikoviae, andRhizoma AM), Er Shen Wan (ESW, consisting of Myristica fragrans and Psoraleacorylifolia) and Ding Zhi Xiao Wan (DZXW, consisting of Codonopsis, Polygalatenuifolia Willd, Acorus Tatarinowii, and Poria Cocos). In addition, Gancao (licorice)is used to mediate other herbs. Suanzaoren (spine date seed) and Hehuanpi (SilktreeAlbizia bark) can be added when the patient suffers from insomnia.

TXYF is recorded in the Dan Xi Xin Fa. Form the viewpoint of TCM, it is used torelieve the pain and diarrhea caused by the incompatibility of the liver and spleen.ESW is recorded in the Pu Ji Ben Shi Fang. Differently, it is used for diarrhea due todeficiency of the spleen. At the patient’s first hospital visit, she mainly complained of

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2061

Figure 2

Figure 2 Endoscopic imaging and corresponding histological findings after Traditional Chinese Medicinetreatment. A: The improvement of ulcers; B: Hematoxylin-eosin-stained rectal ulcers (× 40); C: The healed ulcers.

pain in her left abdomen, diarrhea, mucinous defecation, and abnormal defecation.Based on TCM theory, her clinical symptoms were categorized as diarrhea. Thepatient had mild anxiety, depression and insomnia during her illness. DZXW canmaintain the ability of learning and memory in depression, and the mechanisminvolves the promotion of neural stem cell proliferation in hippocampal formation[10].

TXYF is a commonly used Chinese herbal prescription for diarrhea, suggested to beeffective in treating diarrhea-predominant irritable bowel syndrome (IBS-D)[11]. 5-hydroxytryptamine (5-HT) is a neurotransmitter that is widely distributed throughoutthe central nervous system and gastrointestinal tract, which may contribute to thesymptoms of IBS. Li et al[12] demonstrated that TXYF treatment diminishes colonic 5-HT levels and alleviates the symptoms of IBS-D by favorably affecting microbiotalevels in gut flora communities. Data from a study by Yin et al[13] suggested that theactivity of the enteric nervous system and the regulation of 5-HT and substance Pactivities can be modulated by TXYF. Corticotropin-releasing hormone-receptor 2(known as CRH-R2) is known to activate the intestinal mucosal anti-inflammatoryresponse by regulating migration, proliferation and apoptosis of intestinal epithelialcells, as has been shown in colitis-induced mice[14], and to play an important anti-inflammatory role. Gong et al[14] demonstrated that TXYF can facilitate mucosal repairin colitis mice by regulating the CRH-R2. TXYF was also shown to improve thesymptoms of postinfectious IBS by alleviating behavioral hyperalgesia and exertingantidiarrheal effects, the underlying mechanism of which involves TXYF inhibition ofmucosal mast cells’ activation, down-regulation of tryptase and c-Fos expression, andreduction of serum TNF-α and histamine levels[15]. Therefore, it is suspected that TXYFmay relieve the symptoms of SRUS by decreasing the defecation frequency andpromoting mucosal repair.

AM is the most important herb in TXYF. Studies by Song et al[16] reveal thattreatment with AM significantly stimulates the migration of intestinal epithelial cells(commonly known as IECs) through the polyamine-Kv1 channel signaling pathway,which can promote healing of intestinal injury. Findings from another studysuggested that AM significantly stimulates the migration of IEC-6 cells through apolyamine-dependent mechanism, which could accelerate the healing of intestinalinjury[17]. These results provide evidence for the effect of AM in treating intestinaldiseases that are characterized by injury and ineffective repair of the intestinal mucosain clinical practice.

ESW, composed of Myristica fragrans and Psoralea corylifolia, is a classical Chineseformula for astringing intestines and resolving diarrhea. The Myristica fragrans seed

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2062

extract has shown protective effects against dextran sulfate sodium-induced colitis inan animal model by inhibiting proinflammatory cytokines in the colon mucosa. Thisindicates the potential usefulness of Myristica fragrans to address intestinalinflammation in a preventive application[18]. Psoralea corylifolia is a well-knowntraditional herb used because of its antibacterial activity. Corylifolinin andneobavaisoflavone are two isolated compounds of Psoralea corylifolia. Both of themhave significant antibacterial activity against Staphylococcus aureus, methicillinresistantStaphylococcus aureus, and βlactamase-positive Staphylococcus aureus. Corylifolinin hasbeen shown to produce the largest inhibitory zone (18 mm) with Staphylococcus aureus,being higher than even that of the positive control[19].

Dandelion polysaccharide has a good effect on clearing heat, resolving toxinpresence, dissipating binding, and dispersing swelling. It plays an important role inthe treatment of ulcerative colitis by decreasing the level of interleukin (IL)-6, whichincreases chronic intestinal inflammation[20,21]. Dandelion polysaccharide has also beenshown to effectively regulate the expression of the IL-6 receptors (particularly the αform) and the glycoprotein 130 (commonly known as gp130) protein in the IL-6/transcriptional activator 3 (commonly known as STAT3) pathway, and then down-regulating the expressions of STAT3 and IL-6 mRNAs in intestinal tissue (of rats),thereby alleviating the colon inflammation state and protecting and repairing themucosal tissue[21].

Many neurotransmitters, including dopamine, glutamate, norepinephrine, nitricoxide, and 5-HT and its 5-HT3 and 5-HT4 receptors are expressed in the brain andintestine. Disorder of the bidirectional communication between the intestinal tract andintestinal nervous system and brain (brain-intestinal axis) is regulated by variouspsychosocial and environmental factors (i.e., infection and inflammation)[22].Therefore, the addition of spirit-regulating herbs may be useful for the recovery ofgastrointestinal function.

Clinical application of TCM, DZXW, spine date seed and Silktree Albizia bark hasremarkable effect on quieting the spirit and resolving depression. DZXW has beenshown to effectively ameliorate learning-memory impairment in aging rats,improving their learning-memory capacity, and its mechanism may be related to apromotion of the function of the cerebral monoamine nervous system in brain tissueand a reduction in the level of lipid peroxidation in brain tissue[23]. Finally, theaqueous extract of Albizia adianthifolia leaves shows anxiolytic and antidepressanteffects, and may confer neuroprotection due to alleviation of oxidative stress in the(rat) amygdala induced by 6-hydroxydopamine injection[24].

CONCLUSIONThe case described herein demonstrates that Chinese formulas, specifically modifiedTXYF, can be effective in relieving the symptoms of SRUS. This finding provides newinsight into the treatment of SRUS and a basis for further studies to determine theunderlying mechanism.

REFERENCES1 Martin CJ, Parks TG, Biggart JD. Solitary rectal ulcer syndrome in Northern Ireland. 1971-1980. Br J

Surg 1981; 68: 744-747 [PMID: 7284739 DOI: 10.1002/bjs.1800681021]2 Zhu QC, Shen RR, Qin HL, Wang Y. Solitary rectal ulcer syndrome: clinical features, pathophysiology,

diagnosis and treatment strategies. World J Gastroenterol 2014; 20: 738-744 [PMID: 24574747 DOI:10.3748/wjg.v20.i3.738]

3 Meurette G, Regenet N, Frampas E, Sagan C, Le Borgne J, Lehur PA. The solitary rectal ulcer syndrome.Gastroenterol Clin Biol 2006; 30: 382-390 [PMID: 16633303 DOI: 10.1016/S0399-8320(06)73192-X]

4 Vaizey CJ, van den Bogaerde JB, Emmanuel AV, Talbot IC, Nicholls RJ, Kamm MA. Solitary rectal ulcersyndrome. Br J Surg 1998; 85: 1617-1623 [PMID: 9876062 DOI: 10.1046/j.1365-2168.1998.00935.x]

5 Tjandra JJ, Fazio VW, Petras RE, Lavery IC, Oakley JR, Milsom JW, Church JM. Clinical andpathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome. Dis Colon Rectum1993; 36: 146-153 [PMID: 8425418 DOI: 10.1007/BF02051170]

6 Chiang JM, Changchien CR, Chen JR. Solitary rectal ulcer syndrome: an endoscopic and histologicalpresentation and literature review. Int J Colorectal Dis 2006; 21: 348-356 [PMID: 16133006 DOI:10.1007/s00384-005-0020-6]

7 Uccello M, Malaguarnera G, Basile F, D'agata V, Malaguarnera M, Bertino G, Vacante M, Drago F,Biondi A. Potential role of probiotics on colorectal cancer prevention. BMC Surg 2012; 12 Suppl 1: S35[PMID: 23173670 DOI: 10.1186/1471-2482-12-S1-S35]

8 Waluga M, Zorniak M, Fichna J, Kukla M, Hartleb M. Pharmacological and dietary factors in preventionof colorectal cancer. J Physiol Pharmacol 2018; 69 [PMID: 30149368 DOI: 10.26402/jpp.2018.3.02]

9 Gouriou C, Chambaz M, Ropert A, Bouguen G, Desfourneaux V, Siproudhis L, Brochard C. A systematicliterature review on solitary rectal ulcer syndrome: is there a therapeutic consensus in 2018? Int JColorectal Dis 2018; 33: 1647-1655 [PMID: 30206681 DOI: 10.1007/s00384-018-3162-z]

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2063

10 Shan DH, Chai JY, Wang DS, Wang CT. [Effect of Dingzhixiaowan on Neural Stem Cells of DentateGyrus and Learning Memory in Depression Model Rats]. Zhonghua Zhongyiyao Xuekan 2005; 23: 1426-1427

11 Chen M, Tang TC, Wang Y, Shui J, Xiao XH, Lan X, Yu P, Zhang C, Wang SH, Yao J, Zheng H, HuangDQ. Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48: 160-168 [PMID: 29856472DOI: 10.1111/apt.14817]

12 Li J, Cui H, Cai Y, Lin J, Song X, Zhou Z, Xiong W, Zhou H, Bian Y, Wang L. Tong-Xie-Yao-FangRegulates 5-HT Level in Diarrhea Predominant Irritable Bowel Syndrome Through Gut MicrobiotaModulation. Front Pharmacol 2018; 9: 1110 [PMID: 30323765 DOI: 10.3389/fphar.2018.01110]

13 Yin Y, Zhong L, Wang JW, Zhao XY, Zhao WJ, Kuang HX. Tong Xie Yao Fang relieves irritable bowelsyndrome in rats via mechanisms involving regulation of 5-hydroxytryptamine and substance P. World JGastroenterol 2015; 21: 4536-4546 [PMID: 25914462 DOI: 10.3748/wjg.v21.i15.4536]

14 Gong SS, Fan YH, Wang SY, Han QQ, Lv B, Xu Y, Chen X, He YE. Mucosa repair mechanisms of Tong-Xie-Yao-Fang mediated by CRH-R2 in murine, dextran sulfate sodium-induced colitis. World JGastroenterol 2018; 24: 1766-1778 [PMID: 29713130 DOI: 10.3748/wjg.v24.i16.1766]

15 Ma X, Wang X, Kang N, Chen T, Ji H, Lv L, Yin X, Tian Y, Zheng R, Duan Y, Wang F, Tang X. TheEffect of Tong-Xie-Yao-Fang on Intestinal Mucosal Mast Cells in Postinfectious Irritable BowelSyndrome Rats. Evid Based Complement Alternat Med 2017; 2017: 9086034 [PMID: 28331524 DOI:10.1155/2017/9086034]

16 Song HP, Li RL, Chen X, Wang YY, Cai JZ, Liu J, Chen WW. Atractylodes macrocephala Koidzpromotes intestinal epithelial restitution via the polyamine--voltage-gated K+ channel pathway. JEthnopharmacol 2014; 152: 163-172 [PMID: 24417867 DOI: 10.1016/j.jep.2013.12.049]

17 Song HP, Li RL, Zhou C, Cai X, Huang HY. Atractylodes macrocephala Koidz stimulates intestinalepithelial cell migration through a polyamine dependent mechanism. J Ethnopharmacol 2015; 159: 23-35[PMID: 25446597 DOI: 10.1016/j.jep.2014.10.059]

18 Kim H, Bu Y, Lee BJ, Bae J, Park S, Kim J, Lee K, Cha JM, Ryu B, Ko SJ, Han G, Min B, Park JW.Myristica fragrans seed extract protects against dextran sulfate sodium-induced colitis in mice. J Med Food2013; 16: 953-956 [PMID: 24063406 DOI: 10.1089/jmf.2013.2759]

19 Wang TX, Yin ZH, Zhang W, Peng T, Kang WY. [Chemical constituents from Psoralea corylifolia andtheir antioxidant alpha-glucosidase inhibitory and antimicrobial activities]. Zhongguo Zhongyao Zazhi2013; 38: 2328-2333 [PMID: 24199566]

20 Powell N, Lo JW, Biancheri P, Vossenkämper A, Pantazi E, Walker AW, Stolarczyk E, Ammoscato F,Goldberg R, Scott P, Canavan JB, Perucha E, Garrido-Mesa N, Irving PM, Sanderson JD, Hayee B,Howard JK, Parkhill J, MacDonald TT, Lord GM. Interleukin 6 Increases Production of Cytokines byColonic Innate Lymphoid Cells in Mice and Patients With Chronic Intestinal Inflammation.Gastroenterology 2015; 149: 456-67.e15 [PMID: 25917784 DOI: 10.1053/j.gastro.2015.04.017]

21 Wang Q, Bie YL, Wang D, Fan WT. [Effects of Dandelion polysaccharide on IL-6/STAT3 signalingpathway in ulcerative colitis rats]. Zhongguo Yingyong Shenglixue Zazhi 2017; 33: 422-425 [PMID:29926586]

22 Mach T. The brain-gut axis in irritable bowel syndrome--clinical aspects. Med Sci Monit 2004; 10:RA125-RA131 [PMID: 15173682]

23 Qu R, Ma S, Zhan Y, Xia W. [Effect of dingzhi xiaowan on learning and memory function in aging rats].Zhongguo Linchuang Kangfu 2004; 8: 684-685

24 Beppe GJ, Dongmo AB, Foyet HS, Dimo T, Mihasan M, Hritcu L. The aqueous extract of Albiziaadianthifolia leaves attenuates 6-hydroxydopamine-induced anxiety, depression and oxidative stress in ratamygdala. BMC Complement Altern Med 2015; 15: 374 [PMID: 26481946 DOI:10.1186/s12906-015-0912-0]

WJCC https://www.wjgnet.com August 6, 2019 Volume 7 Issue 15

Zhang LL et al. Two-month follow-up of SRUS

2064

Published By Baishideng Publishing Group Inc

7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Telephone: +1-925-2238242

Fax: +1-925-2238243

E-mail: bpgoffice@wjgnet.com

Help Desk:https://www.f6publishing.com/helpdesk

https://www.wjgnet.com

© 2019 Baishideng Publishing Group Inc. All rights reserved.